Is Magnesium Sulfate Safe in Breastfeeding

I am a breastfeeding mother and i want to know if it is safe to use Magnesium Sulfate? Is Magnesium Sulfate safe for nursing mother and child? Does Magnesium Sulfate extracts into breast milk? Does Magnesium Sulfate has any long term or short term side effects on infants? Can Magnesium Sulfate influence milk supply or can Magnesium Sulfate decrease milk supply in lactating mothers?

El magnesio es un componente natural de la leche.Se utiliza en el tratamiento y profilaxis de la eclampsia y migraña (Pringsheim 2012), en la hipomagnesemia, en ciertas arritmias y como laxante osmótico. Su concentración en la leche es muy estable y depende poco de la alimentación y otros factores, incluida la administración de sulfato de magnesio a la madre: los niveles de magnesio en leche de madres tratadas con sulfato de magnesio intravenoso fueron de 6,4 mg/L frente a 4,8 mg/L en las no tratadas (Cruikshank 1982, Dorea 2000). Su baja biodisponibilidad oral dificulta el paso a plasma del lactante a partir de la leche materna ingerida (Morris 1987) y se considera seguro su uso durante la lactancia (Idama 1998). Se ha observado retraso en al lactogénesis II (subida de la leche) en mujeres tratadas con sulfato de magnesio antes o durante el parto para tratar o prevenir la eclampsia (Haldeman 1993) sí como hipotonía en los recién nacidos, lo que podría interferir en la estimulación mamaria adecuada (Riaz 1998) pero esto puede ser contrarrestado por una decisión materna firme y un apoyo eficaz a la madre (Cordero 2012). Academia Americana de Pediatría: medicación usualmente compatible con la lactancia.Listado de medicamentos esenciales OMS 2002: compatible con la lactancia.

Intravenous magnesium increases milk magnesium concentrations only slightly and oral absorption of magnesium by the infant is poor, so maternal magnesium therapy is not expected to affect the breastfed infant's serum magnesium. Although intravenous magnesium sulfate given prior to delivery might affect the infant's ability to breastfeed, intention to breastfeed may be a more important determinant of breastfeeding initiation.[1] Postpartum use of intravenous magnesium sulfate for longer than 6 hours appears to delay the onset of lactation.[2][3]

Fifty mothers who were in the first day postpartum received 15 mL of either mineral oil or an emulsion of mineral oil and another magnesium salt, magnesium hydroxide equivalent to 900 mg of magnesium hydroxide, although the exact number who received each product was not stated. Additional doses were given on subsequent days if needed. None of the breastfed infants were noted to have any markedly abnormal stools, but all of the infants also received supplemental feedings.[5]

One mother who received intravenous magnesium sulfate for 3 days for pregnancy-induced hypertension had lactogenesis II delayed until day 10 postpartum. No other specific cause was found for the delay, although a complete work-up was not done.[6] A subsequent controlled clinical trial found no evidence of delayed lactation in mothers who received intravenous magnesium sulfate therapy.[7] Some, but not all, studies have found a trend toward increased time to the first feeding or decreased sucking in infants of mothers treated with intravenous magnesium sulfate during labor because of placental transfer of magnesium to the fetus.[7][8] Another study found that among women with severe pre-eclampsia who received intravenous magnesium sulfate for up to one day postpartum and who intended to breastfeed, 85% of infants receiving routine well-baby care and 69% of those admitted to the NICU, breastfeeding was successfully initiated.[1] A study randomized women with preeclampsia to receive intravenous magnesium sulfate for either 6 or 24 hours postpartum. There was no difference in the rate of eclampsia between the two groups. However, those who received the infusion for 24 hours had a delayed onset of lactation, 36.5 hours compared with 25.7 hours in the 6-hour group.[2] A prospective, multicenter, randomized, controlled trial in 9 Latin American maternity hospitals compared patients with severe pre-eclampsia who had received at least 8 grams of magnesium sulfate prior to placebo. Patients were randomized to continue magnesium sulfate for 24 hours postpartum (n = 555) or stopping the infusion (n = 558). There was no difference in the rates of eclampsia between the groups, but the time to lactation was significantly delayed in those who received magnesium sulfate postpartum (24.1 vs. 17.1 hours).[3]